[Abdominal Sonography in Medical Emergencies: do Complete Abdominal Scans offer Advantages over a Focused Strategy?] / Internistische Sonografie des Abdomens für Notaufnahmepatienten: Bietet eine vollständige Abdominalsonografie Vorteile?

PURPOSE: To determine, whether in case of abdominal emergencies, complete abdominal ultrasound scans offer advantages over a goal-directed strategy in regard to problem-solving and detection of relevant pathologies. MATERIAL AND METHODS: Retrospective analysis of consecutive emergency exams that were ordered by the ER in our gastroenterological sonography unit from 06/2012 to 06/2013. All patients got an ultrasound of the complete abdomen.We compared the findings of the complete abdomen study with the findings of a hypothetical focused sonography. The scope of the focused sonography depended on the presenting problem. An ultrasound finding was classified as relevant, if it triggered diagnostic or therapeutic consequences.Sensitivity and negative predictive value of the goal-directed strategy were calculated with the full abdominal scan as reference. RESULTS: 629 patients (53 % female), with an average age of 59 years (18-97) had emergency sonographies.Focused sonography detected relevant pathologies in 63 % (396/629) of patients. In 17 % of patients (106/629) complete abdominal ultrasound led to additional relevant findings. This translates into a number needed to scan for relevant pathologies of 6. Focused sonography had a sensitivity of 76 % and a negative predictive value of 64 % for relevant pathologies.The problem could be solved by 57 % of focused sonographies, whereas complete abdominal scans solved the problem in 63 % for a number needed to scan of 18. Sensitivity and negative predictive value of focused sonography were 87 % and 63 % respectively.The rate of problem-solving-scans depended on the indication (with jaundice having the highest (90 %) and left-upper-quadrant pain having the lowest (45 %) rate) and increased with age (37 % for the second decade up to 85 % for the 10th decade). CONCLUSION: In medical abdominal emergencies, ultrasound scans of the complete abdomen detect more relevant pathologies and solve more problems than focused sonography does.

Effect of a selective endothelin receptor A blocker on cardiovascular remodeling in uninephrectomized spontaneously hypertensive rats of the stroke-prone strain.

BACKGROUND/AIMS: The role of endothelin (ET) in cardiovascular remodeling was investigated by treating uninephrectomized spontaneously hypertensive rats of the stroke-prone strain (UNX-SHRsp) on normal- or high (3%)-salt diet with the selective ET(A) receptor blocker LU 135252. METHODS: SHRsp on normal or high salt were sham-operated (n = 10/11) or UNX; UNX received no treatment (n = 10/15) or 100 mg/kg body weight LU 135252 (n = 10/10). Systolic blood pressure (BP) was measured weekly. After perfusion fixation the heart and the aorta were analyzed using quantitative morphological and stereological techniques. RESULTS: No effect was seen in normal-salt groups. In high-salt animals UNX caused left ventricular (LV) hypertrophy which was prevented by LU 135252 (p < 0.001). LU 135252 only lowered BP during the last 2 weeks of the 12-week experiment. UNX showed hypertrophic remodeling of intramyocardial arterioles. Treatment with LU 135252 caused lower wall:lumen ratio and wall thickness of LV intramyocardial arterioles (p < 0.01). In the descending thoracic aorta UNX caused thickening of the media. The media area and the wall:lumen ratio were lower in UNX + LU 135252 as compared to untreated UNX (p < 0.01 and p < 0.05, respectively). CONCLUSION: In SHRsp UNX causes hypertrophic cardiovascular remodeling only in the presence of salt loading. These effects are largely BP-independent and prevented by ET(A) receptor blockade.